The source of information is an observational registry of consecutive cases of cancer-associated PE, who received care at 14 Spanish hospitals between 2004 and 2015 (Registro de Embolia Pulmonar en Pacientes con Neoplasias, EPIPHANY registry for its Spanish acronym). Briefly put, the basic eligibility criteria required that patients be adults (⩾18 years) with a PE diagnosis confirmed by means of objective imaging (CT angiography scans, high probability scintigraphy, or CT scheduled to assess tumour response or for other reasons). In order to choose a truly oncological population, subjects were withdrawn from the study if the PE had occurred more than 1 month prior to the diagnosis of cancer, or if more than 1 month had elapsed since completing adjuvant chemotherapy. Patients were also excluded if they had not received anticoagulant therapy without justification
according to international clinical practice guidelines. In case of multiple events, only one was considered to be the index PE, defined as the evaluable PE closest to the time of recruitment. The main objective of this study was to develop a prognostic model, the EPHIPANY index, for cancer patients and both incidental, as well as symptomatic PE.
The main outcome measure in this study was the occurrence of a serious medical condition between PE diagnosis on imaging and 15 days later. Serious complications are events that lead to serious clinical deterioration or death; for example, systolic blood pressure <90 mm Hg, acute respiratory failure, right-side heart failure, acute kidney failure, major bleeding, or any other event the investigator deems serious.
We used the Exhaustive CHAID algorithm to build a decision tree by means of repeated partitionsof each subset into two or more child nodes.This approach was used to obtain an actionable tool for decision making (see Scope).
Disclaimer: This tool is intended for use by healthcare professionals only. Patients with pulmonary embolism should seek medical care urgently. Physicians and other healthcare professionals who use epiphany should exercise their own clinical judgment. This app do not give professional advice. We have cautiously tried to create this app based on real-world data. However, standards and practice in medicine may vary as new information become available and professionals should consult a diversity of medical sources. We tried to provide an estimation of risk for cancer patients with pulmonary embolism (PE), but we do not endorse any particular management strategy. In particular we did not developed this tool to reduce the level of supportive care for PE patients. Your reliance upon predictions obtained through this app is solely at your own risk. We do not assume any liability or responsibility for damage or injury (including death) to you or other people from any use of this tool.
Carmona-Bayonas A, Jiménez-Fonseca P, et al (2017). Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index. British Journal of Cancer, 116(8), 994.
Ahn S, et al. (2018). Validation of the EPIPHANY index for predicting risk of serious complications in cancer patients with incidental pulmonary embolism. Supportive Care in Cancer, 26(10), 3601-3607.
Weeda ER, et al (2019). External validation of three risk stratification rules in patients presenting with pulmonary embolism and cancer. Supportive Care in Cancer, 27(3), 921-925.